Search

Background There are few data assessing the uptake of first-line dolutegravir among men and women living with HIV in low-income and middle-income countries, and subsequent clinical outcomes in non-trial settings. We aimed to determine dolutegravir uptake in women, and the effect of dolutegravir on clinical outcomes in routine care in South Africa. Methods In this cohort study, we analysed deidentified data from adults receiving first-line antiretroviral therapy (ART) at 59 South African clinics from Dec 1, 2019, to Feb 28, 2022, using two distinct cohorts. In the initiator cohort, we used Poisson regression models to assess the outcome of initiation with dolutegravir-based ART by gender, and associations between dolutegravir use and the outcomes of 12-month retention in care and viral suppression at less than 50 copies per mL. In the transition cohort, comprising adults who received non-dolutegravir-based first-line ART in December, 2019, we used Cox proportional hazards models to assess the outcome of transition to first-line dolutegravir by gender. We then used time-dependent propensity score matching to compare the outcomes of subsequent 12-month retention in care and viral suppression between people who transitioned to dolutegravir and those who had not yet transitioned at the same timepoint. In both the initiation and transition cohort, the primary viral load analysis was an intention-to-treat analysis, with a secondary as-treated analysis that excluded people who changed their ART regimen after baseline. Findings In the initiator cohort, between Dec 1, 2019, and Feb 28, 2022, 45 392 people were initiated on ART. 23 945 (52·8%) of 45 392 were non-pregnant women, 4780 (10·5%) were pregnant women, and 16 667 (36·7%) were men. The median participant age was 31·0 years (IQR 26·0–38·0) and 2401 (5·3%) were receiving tuberculosis treatment at time of ART initiation. 31 264 (68·9%) of 45 392 people were initiated on dolutegravir, 14 102 (31·1%) on efavirenz, and 26 (0·1%) on nevirapine. In a univariable Poisson regression model, pregnant women (risk ratio [RR] 0·57, 95% CI 0·49 to 0·66; risk difference –35·4%, 95% CI –42·3 to –28·5) and non-pregnant women (RR 0·78, 0·74 to 0·82; risk difference –18·4%, –21·6 to –15·2) were less likely to be initiated on dolutegravir than were men. In Poisson models adjusted for age, gender (including pregnancy), time, tuberculosis status, and initiation CD4 count, people initiated on dolutegravir were more likely to be retained in care at 12 months (adjusted RR 1·09, 95% CI 1·04 to 1·14; adjusted risk difference 5·2%, 2·2 to 8·4) and virally suppressed (adjusted RR 1·04, 95% CI 1·01 to 1·06; adjusted risk difference 3·1%, 1·2 to 5·1) compared with those initiated on non-dolutegravir-based regimens. For the transition cohort, on Dec 1, 2019, 180 956 people were receiving non-dolutegravir-based first-line ART at the study clinics, of whom 124 168 (68·6%) were women. The median age was 38 years (IQR 32–45), and the median time on ART was 3·9 years (2·0–6·4) years, with most people receiving efavirenz (178 624 [98·7%] people) and tenofovir (178 148 [98·4%]). By Feb 28, 2022, 121 174 (67·0%) of 180 956 people had transitioned to first-line dolutegravir at a median of 283 days (IQR 203–526). In a univariable Cox regression model the hazard of being transitioned to dolutegravir was lower in women than in men (hazard ratio 0·56, 95% CI 0·56 to 0·57). Among 92 318 propensity score matched people, the likelihood of retention in care was higher among the dolutegravir group compared with matched controls (adjusted RR 1·03, 95% CI 1·02 to 1·03; risk difference 2·5%, 95% CI 2·1 to 2·9). In the dolutegravir group, 33 423 (90·5%) of 36 920 people were suppressed at less than 50 copies per mL compared with 31 648 (89·7%) of 35 299 matched controls (adjusted RR 1·01, 95% CI 1·00 to 1·02; risk difference 0·8%, 95% CI 0·3 to 1·4). Interpretation Women were less likely to receive dolutegravir than men. As dolutegravir was associated with improved outcomes, roll-out should continue, with a particular emphasis on inclusion of women. Funding Wellcome Trust, Africa Oxford Initiative, International Association of Providers of AIDS Care, and Bill & Melinda Gates Foundation. Translation For the isiZulu translation of the abstract see Supplementary Materials section.

Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is the leading cause of preventable death in hospitalised people and the third most common cause of mortality in surgical patients. People undergoing bariatric surgery have the additional risk factor of being overweight. Although VTE prophylaxis in surgical patients is well established, the best way to prevent VTE in those undergoing bariatric surgery is less clear.To evaluate the benefits and harms of pharmacological interventions (alone or in combination) on venous thromboembolism and other health outcomes in people undergoing bariatric surgery compared to the same pharmacological intervention administered at a different dose or frequency, the same pharmacological intervention or started at a different time point, another pharmacological intervention, no intervention or placebo.We used standard, extensive Cochrane search methods. The latest search date was 1 November 2021.We included randomised controlled trials (RCTs) and quasi-RCTs in males and females of any age undergoing bariatric surgery comparing pharmacological interventions for VTE (alone or in combination) with the same pharmacological intervention administered at a different dose or frequency, the same pharmacological intervention started at a different time point, a different pharmacological intervention, no treatment or placebo.We used standard Cochrane methods. Our primary outcomes were 1. VTE and 2. major bleeding. Our secondary outcomes were 1. all-cause mortality, 2. VTE-related mortality, 3. PE, 4. DVT, 5. adverse effects and 6. quality of life. We used GRADE to assess certainty of evidence for each outcome.We included seven RCTs with 1045 participants. Data for meta-analysis were available from all participants. Four RCTs (597 participants) compared higher-dose heparin to standard-dose heparin: one of these studies (139 participants) used unfractionated heparin (UFH) and the other three (458 participants) used low-molecular-weight heparin (LMWH). One study compared heparin versus pentasaccharide (198 participants), and one study compared starting heparin before versus after bariatric surgery (100 participants). One study (150 participants) compared combined mechanical and pharmacological (enoxaparin) prophylaxis versus mechanical prophylaxis alone. The duration of the interventions ranged from seven to 15 days, and follow-up ranged from 10 to 180 days. Higher-dose heparin versus standard-dose heparin Compared to standard-dose heparin, higher-dose heparin may result in little or no difference in the risk of VTE (RR 0.55, 95% CI 0.05 to 5.99; 4 studies, 597 participants) or major bleeding (RR 1.19, 95% CI 0.48 to 2.96; IHigher-dose heparin may make little or no difference to venous thromboembolism or major bleeding in people undergoing bariatric surgery when compared to standard-dose heparin. Heparin may make little or no difference to venous thromboembolism in people undergoing bariatric surgery when compared to pentasaccharide. There are inadequate data to draw conclusions about the effects of heparin compared to pentasaccharide on major bleeding. Starting prophylaxis with heparin 12 hours before bariatric surgery may make little or no difference to venous thromboembolism in people undergoing bariatric surgery when compared to starting heparin after bariatric surgery. There are inadequate data to draw conclusions about the effects of heparin started before versus after surgery on major bleeding. Combining mechanical and pharmacological prophylaxis (started 12 hours before surgery) may reduce VTE events in people undergoing bariatric surgery when compared to mechanical prophylaxis alone. No data are available relating to major bleeding. The certainty of the evidence is limited by small sample sizes, few or no events, and risk of bias concerns. Future trials must be sufficiently large to enable analysis of relevant clinical outcomes, and should standardise the time of treatment and follow-up. They should also address the effect of direct oral anticoagulants and antiplatelets, preferably grouping them according to the type of intervention.

The cerebral pressure reactivity index (PRx), through intracranial pressure (ICP) measurements, informs clinicians about the cerebral autoregulation (CA) status in adult-sedated patients with traumatic brain injury (TBI). Using PRx in clinical practice is currently limited by variability over shorter monitoring periods. We applied an innovative method to reduce the PRx variability by ventilator-induced slow (1/min) positive end-expiratory pressure (PEEP) oscillations. We hypothesized that, as seen in a previous animal model, the PRx variability would be reduced by inducing slow arterial blood pressure (ABP) and ICP oscillations without other clinically relevant physiological changes. Patients with TBI were ventilated with a static PEEP for 30 min (PRx period) followed by a 30-min period of slow [1/min (0.0167 Hz)] +5 cmH2O PEEP oscillations (induced (iPRx period). Ten patients with TBI were included. No clinical monitoring was discontinued and no additional interventions were required during the iPRx period. The PRx variability [measured as the standard deviation (SD) of PRx] decreased significantly during the iPRx period from 0.25 (0.22-0.30) to 0.14 (0.09-0.17) (P = 0.006). There was a power increase around the induced frequency (1/min) for both ABP and ICP (P = 0.002). In conclusion, 1/min PEEP-induced oscillations reduced the PRx variability in patients with TBI with ICP levels

Background The COVID-19 pandemic has highlighted personal protective equipment (PPE) supply, distribution, and disposal issues worldwide. Calls to conserve PPE stocks and increase supply resulted in the rapid development of potential disinfection methods, with the possibility of improvements in medical waste reduction. However, how receptive health-care workers are to PPE reuse remains unknown. We aimed to examine the views of health-care workers who used PPE during the first COVID-19 wave in Aotearoa New Zealand, in relation to acceptability of PPE disinfection and reuse. Methods In this multi-methods survey, health-care workers in New Zealand, were invited via a multimodal recruitment strategy to complete a survey regarding use of PPE during the first COVID-19 wave. Gender question options were male, female, gender diverse, or prefer not to say. Demographic differences in self-reported PPE reuse and acceptability were examined. The survey included closed (single-response, multi-response, ranking, and Likert-scale questions) and open-text questions. Any open-text comments were analysed with thematic analysis. The survey was built and deployed using Qualtrics software. Findings 1411 health-care workers completed the survey between Oct 7 and Nov 30, 2020. 1397 participants had gender data available (1140 [82%] female and 257 [18%] male) and 995 (74%) of 1347 were of New Zealand European ethnicity. PPE reuse was common and reported by 628 (45%) of the 1411 participants, with 396 (63%) of the 628 reporting reusing PPE multiple times in 1 day. Acceptability of the concept of PPE disinfection for potential reuse was high overall (1196 [85%] of 1411) but varied depending on the type of PPE. Thematic analysis confirmed that PPE reuse was already occurring and respondents recognised the potential benefits of reduced medical wastage and increased PPE supply. Important caveats for consideration included the availability of scientific evidence, level of negotiated risk, and trust in the organisation undertaking PPE disinfection, with clear communication about decontamination processes being crucial to acceptability. Interpretation PPE reuse occurred frequently during the first wave of COVID-19 in New Zealand. Although support for the disinfection of PPE for reuse was high, the success of any future programmes to reuse PPE will require meaningful engagement and clear communication with health-care workers. Further research into PPE disinfection safety and logistics is warranted, alongside the development of standard operating procedures and clearly communicated policies for the end user, should this more sustainable health-care practice be planned for adoption in certain settings. Funding New Zealand Ministry of Business, Innovation and Employment (COVID-19 Innovation Acceleration Fund) and the Medical Assurance Society Foundation.

La que era una norma plausible, com la que va establir el concili de Trento (1545-1563), la de predicar i fer la catequesi del poble en la llengua vernacla, volia evitar que es fes en la llengua sàvia, el llatí, que ja el poble no l’entenia. Els sínodes diocesans mallorquins aplicaren aquella pauta, conservada en el de 1691, vigent fins al sínode de 1932. El catecisme del P. Ledesma es va publicar sempre en català, des del segle XVI al XIX, i esdevingué el llibre per aprendre a llegir i escriure. Va ser la Reial Cèdula de Carles IV (III), de 1768, que manava que s’implantàs la llengua castellana en les escoles, el que va trencar la pau en les esglésies i en les escoles, punint fins i tot els eclesiàstics que predicaven la catequesi en mallorquí. Tanmateix, l’any 1801, el bisbe Bernat Nadal va publicar el primer catecisme diocesà en català, contra el manament de l’esmentada Reial Cèdula. El seu catecisme i el del P. Ledesma, editats al llarg del segle, foren la base per a l’alfabetització de la majoria dels infants.

Right-sided cardiac thrombus is rare and may be caused by venous thromboembolism, in association with medical devices or stasis of blood in atrial fibrillation (AF) and cardiomyopathies. Complications include pulmonary embolism (PE) and paradoxical stroke. Current data are limited and mostly from case series and PE registries. We aimed to describe the clinical characteristics, echocardiographic features, treatments, and outcomes of right-sided cardiac thrombus patients.This was a retrospective observational study of 97 consecutive patients with right-sided cardiac thrombus detected on echocardiography. We studied co-morbidities, predisposing factors, thrombus characteristics, and therapeutic interventions and assessed their associations with the development of PE, paradoxical stroke, circulatory collapse, and all-cause mortality.The mean age was 58.7 years, and 55/97 (56.7%) of the participants were female. Ischemic heart disease (IHD), heart failure, chronic kidney disease, and malignancy were common co-morbidities. Right atrial (RA) thrombus was often associated with medical devices, while right ventricular (RV) thrombus was more commonly associated with cardiomyopathy. Thrombus mobility did not affect embolic events but was associated with greater short-term mortality. On multivariable analysis, anticoagulation (HR 0.25, 95% CI 0.09-0.68) and thrombus resolution (HR 0.28, 95% CI 0.13-0.62) were associated with greater survival.Right-sided cardiac thrombus is rare but may have potentially life-threatening complications such as PE and paradoxical stroke. Further research is needed to determine the optimal therapeutic strategies for this poorly studied population.

Nonlinear ultrasonic emissions produced during a therapeutic ultrasound procedure can be detected, localized, and quantified through a class of methods that can be referred to as passive acoustic mapping (PAM). While a variety of PAM beamforming algorithms may be employed, they share a common limitation that a single sound speed is specified for both phase steering of array elements and for calculation of source power or energy. The specified value may be inadequate whether derived from B-mode-based metrics or literature values for constituent materials. This study employed experiments and simulations with linear and curvilinear array geometries to investigate the impact of in situ sound speed uncertainties on source localization in layered media. The data were also used to evaluate a new method for optimizing coregistration of PAM and B-mode images. Coregistration errors as large as 10 mm were observed with the curvilinear array, which also showed much greater sound speed sensitivity than the linear array. Errors with both array geometries were typically reduced to the order of 0.1 mm using the proposed optimization method regardless of beamformer choice or whether the array was calibrated. In a further step toward reliable implementation of PAM, the current work provides an approach that can help ensure that therapeutic ultrasound procedures are accurately guided by cavitation emissions.

The aim of this study was to verify the effects of moderate-intensity continuous (MICT) and high-intensity interval (HIIT) aerobic training on cardiac morphology and function and the mechanical properties of single cardiomyocytes in spontaneously hypertensive rats (SHR) in the compensated phase of hypertension. Sixteen-week-old male SHR and normotensive Wistar (WIS) rats were allocated to six groups of six animals each: SHR CONT or WIS CONT (control); SHR MICT or WIS MICT (underwent MICT, 30 min/day, five days per week for eight weeks); and SHR HIIT or WIS HIIT (underwent HIIT, 30 min/day, five days per week for eight weeks). Total exercise time until fatigue and maximum running speed were determined using a maximal running test before and after the experimental period. Systolic (SAP), diastolic (DAP), and mean (MAP) blood pressures were measured using tail plethysmography before and after the experimental period. Echocardiographic evaluations were performed at the end of the experimental period. The rats were euthanized after in vivo assessments, and left ventricular myocytes were isolated to evaluate global intracellular Ca2+ transient ([Ca2+]i) and contractile function. Cellular measurements were performed at basal temperature (~37°C) at 3, 5, and 7 Hz. The results showed that both training programs increased total exercise time until fatigue and, consequently, maximum running speed. In hypertensive rats, MICT decreased SAP, DAP, MAP, interventricular septal thickness during systole and diastole, and the contraction amplitude at 5 Hz. HIIT increased heart weight and left ventricular wall thickness during systole and diastole and reduced SAP, MAP, and the time to peak [Ca2+]i at all pacing frequencies. In conclusion, both aerobic training protocols promoted beneficial adaptations to cardiac morphology, function, and mechanical properties of single cardiomyocytes in SHR.

Every year, more than 600000 horseshoe crabs are bled to produce Limulus amoebocyte lysate, which is used to detect Gram-negative bacteria in biomedical products. While numerous studies have shown that some horseshoe crabs die after being bled, less is known about what happens to those that are returned to their natural habitat. In this study, we used an array of VR2W acoustic receivers to track 10 bled and 10 control females during the mating season in the Great Bay Estuary, NH, USA. Animals were bled, or not, released where they had been initially captured, and tracked from 22 May to 26 June 2019. Bled and control females moved comparable distances at similar speeds during the weeks after they were released (controls: 90.3 m h-1; bled: 89.7 m h-1). The longer horseshoe crabs remained within the virtual positioning system array, the longer we were able to track them and the more beach approaches and mating attempts we were able to identify. When this relationship between the duration of time we were able to track a horseshoe crab and how many apparent mating attempts it expressed was taken into account, we found that bled females attempted to spawn half as often as control females, and this difference was significant. Overall, these data are consistent with previous findings indicating that females that are released back into their natural habitat after bleeding express similar levels of activity and seasonal movements but attempt to mate less than control animals, at least in the first few weeks after being bled.

Although current evidence is in favor of metabolic health and nonobesity in the reduction of incident cardiovascular disease, little is known regarding the prognosis across the metabolic phenotypes once cardiovascular disease occurs. This study examined the prognosis of patients with significant aortic stenosis (AS) on the basis of the presence of metabolic health and obesity. This a retrospective cohort study on consecutive patients who presented with moderate-to-severe AS to a tertiary hospital between 2010 and 2015. Patients were allocated into 4 groups on the basis of obesity and metabolic health: metabolically healthy obese (MHO), metabolically healthy nonobese (MHNO), metabolically unhealthy obese (MUO), and metabolically unhealthy nonobese (MUNO). Metabolic health was defined in accordance to the Adult Treatment Panel III criteria. The primary outcome was all-cause mortality. Cox regression examined independent associations between mortality and metabolic phenotypes, adjusting for aortic valve area, ejection fraction, age, gender, chronic kidney disease, and aortic valve replacement as a time-dependent covariate. Of 727 patients, the majority (51.6%) were MUNO, followed by MUO (32.7%), MHNO (11.4%), and MHO (4.3%). MHNO had the highest mortality (43.0%), followed by the MUNO (37.5%), MUO (30.0%), and MHO (6.9%) groups (p = 0.001). Compared with MHNO, MHO (hazard ratio 0.159, 95% confidence interval 0.038 to 0.668, p = 0.012) and MUO (hazard ratio 0.614, 95% confidence interval 0.403 to 0.937, p = 0.024) were independently associated with lower all-cause mortality rates after adjusting for confounders. In patients who are obese, metabolic health had favorable survival compared with metabolically unhealthy (p = 0.015), but this protective impact of metabolic health was not observed in patients with overweight or normal weight. Obesity had favorable survival compared with overweight and normal weight in both patients who are metabolically healthy (p = 0.002) and unhealthy (p = 0.007). In conclusion, patients who are MHO with AS have the most favorable prognosis, whereas the seemingly healthy MHNO group had the worst survival. There should be a paradigm shift toward prioritizing metabolic health rather than weight reduction in patients with significant AS.

Surveys with the James Webb Space Telescope (JWST) have discovered candidate galaxies in the first 400 Myr of cosmic time. Preliminary indications have suggested these candidate galaxies may be more massive and abundant than previously thought. However, without confirmed distances, their inferred properties remain uncertain. Here we identify four galaxies located in the JWST Advanced Deep Extragalactic Survey Near-Infrared Camera imaging with photometric redshifts z of roughly 10–13. These galaxies include the first redshift z > 12 systems discovered with distances spectroscopically confirmed by JWST in a companion paper. Using stellar population modelling, we find the galaxies typically contain 100 million solar masses in stars, in stellar populations that are less than 100 million years old. The moderate star-formation rates and compact sizes suggest elevated star-formation rate surface densities, a key indicator of their formation pathways. Taken together, these measurements show that the first galaxies contributing to cosmic reionization formed rapidly and with intense internal radiation fields.

This research investigates the relationship between housing wealth and residential satisfaction. Using household panel survey data from the UK, we find that individuals’ asymmetric responses to changes in housing wealth distribution, i.e., loss aversion experienced by the worse-off group, could offset the gain from an increase in housing wealth at the aggregate level. Consequently, housing wealth growth does not necessarily improve residential satisfaction for the society as a whole if it leads to housing wealth inequality. Given the significant impact of housing wealth distribution on residential satisfaction, it is important to consider housing wealth inequality in making public policy decisions.

Antiplatelet agents may be useful for the treatment of deep venous thrombosis (DVT) when used in addition to best medical practice (BMP), which includes anticoagulation, compression stockings, and clinical care such as physical exercise, skin hydration, etc. Antiplatelet agents could minimise complications such as post-thrombotic syndrome (PTS) and pulmonary embolism (PE). They may also reduce the recurrence of the disease (recurrent venous thromboembolism (recurrent VTE)). However, antiplatelet agents may increase the likelihood of bleeding events.To assess the effects of antiplatelet agents in addition to current BMP compared to current BMP (with or without placebo) for the treatment of DVT.The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 7 December 2021. The review authors searched LILACS and IBECS databases (15 December 2021) and also checked the bibliographies of included trials for further references to relevant trials, and contacted specialists in the field, manufacturers and authors of the included trials.We considered randomised controlled trials (RCTs) examining antiplatelet agents compared to BMP following initial standard anticoagulation treatment for DVT. We included studies where antiplatelet agents were given in addition to current BMP compared to current BMP (with or without placebo) for the treatment of DVT (acute: treatment started within 21 days of symptom onset; chronic: treatment started after 21 days of symptom onset). We evaluated only RCTs where the antiplatelet agents were the unique difference between the groups (intervention and control).We used standard Cochrane methodological procedures. Two review authors independently extracted data and assessed risk of bias of the trials. Any disagreements were resolved by discussion with a third review author. We calculated outcome effects using risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) and the number needed to treat to benefit (NNTB).We included six studies with 1625 eligible participants, with data up to 37.2 months of follow-up. For one preplanned comparison (i.e. antiplatelet agents plus BMP versus BMP plus placebo) for acute DVT we identified no eligible studies for inclusion. In acute DVT, antiplatelet agents plus BMP versus BMP alone was assessed by one study (500 participants), which reported on four outcomes until 6 months of follow-up. There were no deaths and no cases of major bleeding reported. The participants who received antiplatelet agents showed a lower risk of PTS (RR 0.74, 95% CI 0.61 to 0.91; 1 study, 500 participants; very low-certainty evidence). The control group presented a lower risk of adverse events compared to the intervention group (RR 2.88, 95% CI 1.06 to 7.80; 1 study, 500 participants; very low-certainty evidence). This study did not provide information for recurrent VTE or PE. In chronic DVT, antiplatelet agents plus BMP versus BMP alone was assessed by one study (224 participants). The study authors reported four relevant outcomes, three of which (major bleeding, mortality and adverse events) showed no events during the 3 years of follow-up. Therefore, an effect estimate could only be reported for recurrent VTE, favouring antiplatelet agents plus BMP versus BMP alone (RR 0.12, 95% CI 0.05 to 0.34; 1 study, 224 participants; very low-certainty evidence). For the outcomes PE and PTS, this study did not present information which could be used for analysis. In chronic DVT, antiplatelet agents plus BMP versus BMP plus placebo was assessed by four studies (901 participants). The meta-analysis of this pooled data showed a lower risk of recurrent VTE for the antiplatelet agents group (RR 0.65, 95%, CI 0.43 to 0.96; NNTB = 14; low-certainty evidence). For major bleeding, we found no clear difference between placebo and intervention groups until 37.2 months of follow-up (RR 0.98, 95% CI 0.29 to 3.34; 1 study, 583 participants; moderate-certainty evidence). In PE fatal/non-fatal outcome, we found no clear difference with the use of antiplatelet agents (RR 0.52, 95% CI 0.23 to 1.14; 1 study, 583 participants; moderate-certainty evidence). For all-cause mortality, the overall effect of antiplatelet agents did not differ from the placebo group (RR 0.48, 95% CI 0.21 to 1.06; 3 studies, 649 participants; moderate-certainty evidence). The adverse events outcome did not show a clear difference (RR 1.57, 95% CI 0.34 to 7.19; 2 studies, 621 participants; moderate-certainty evidence). There is no assessment of PTS in these studies. We downgraded the certainty of evidence for risk of bias, indirectness, imprecision and publication bias.In chronic DVT settings, following the initial standard treatment with anticoagulants, there is low-certainty evidence that antiplatelet agents in addition to BMP may reduce recurrent VTE, (NNTB = 14) when compared to BMP plus placebo. Moderate-certainty evidence shows no clear difference in adverse events, major bleeding and PE when antiplatelet agents are used in addition to BMP compared to BMP plus placebo. In acute and chronic DVT settings, following the initial standard treatment with anticoagulants, we can draw no conclusions for antiplatelet agents in addition to BMP compared to BMP alone due to very low-certainty evidence. Trials of high methodological quality, that are large and of sufficient duration to detect significant clinical outcomes are needed. Trials should ideally last more than 4 years in order to estimate the long-term effect of antiplatelet agents. Trials should include people with acute and chronic DVT and provide relevant individual data, such as the outcome for each index event (DVT or PE), the use of an inferior vena cava (IVC) filter, whether the DVT is provoked or unprovoked, and the age of participants.

BACKGROUND: The European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS) has been accepted as a robust tool to evaluate the magnitude of clinical benefit reported in trials for oncological therapies. However, the ESMO-MCBS hitherto has only been validated for solid tumours. With the rapid development of novel therapies for haematological malignancies, we aimed to develop an ESMO-MCBS version that is specifically designed and validated for haematological malignancies. METHODS: ESMO and the European Hematology Association (EHA) initiated a collaboration to develop a version for haematological malignancies (ESMO-MCBS:H). The process incorporated five landmarks: field testing of the ESMO-MCBS version 1.1 (v1.1) to identify shortcomings specific to haematological diseases, drafting of the ESMO-MCBS:H forms, peer review and revision of the draft based on re-scoring (resulting in a second draft), assessment of reasonableness of the scores generated, final review and approval by ESMO and EHA including executive boards. RESULTS: Based on the field testing results of 80 haematological trials and extensive review for feasibility and reasonableness, five amendments to ESMO-MCBS were incorporated in the ESMO-MCBS:H addressing the identified shortcomings. These concerned mainly clinical trial endpoints that differ in haematology versus solid oncology and the very indolent nature of nevertheless incurable diseases such as follicular lymphoma, which hampers presentation of mature data. In addition, general changes incorporated in the draft version of the ESMO-MCBS v2 were included, and specific forms for haematological malignancies generated. Here we present the final approved forms of the ESMO-MCBS:H, including instructions. CONCLUSION: The haematology-specific version ESMO-MCBS:H allows now full applicability of the scale for evaluating the magnitude of clinical benefit derived from clinical studies in haematological malignancies.

Background: Chronic kidney disease (CKD) is one of the leading causes of mortality globally. The prevalence of risk factors associated with CKD is on the rise in Nigeria. Early recognition and treatment of risk factors can prevent or slow down disease progression. Objectives: This study aimed to determine the prevalence of chronic kidney disease and some of its risk factors among health workers at Alex-Ekweueme Federal University Teaching Hospital, Abakaliki. Methodology: This was a cross-sectional study conducted as part of the activities to commensurate world kidney day. Consecutive volunteers were screened. Their biodata, anthropometric data, and blood pressures were obtained. Blood glucose was determined by glucometer, a urine sample was collected for urinalysis, and a blood sample was taken for serum creatinine. The estimation of glomerular filtration rate (eGFR) was calculated using the modification of diet in renal disease ( MDRD) formula. Results: 390 members of staff were screened. There were 152 (39%) males and 238 (61%) females. The mean age was 38.19 ± 10.24years. CKD risk factors were obesity (32.8%), hypertension (26.4%), proteinuria (11.0%) and diabetes mellitus (6.2%). 31.0% had CKD (eGFRConclusion: Chronic kidney disease and its risk factors were prevalent among the participants. A healthy lifestyle and regular screening among health workers should be encouraged to curb CKD and its risk factors.

The Gene Ontology (GO) knowledgebase (http://geneontology.org) is a comprehensive resource concerning the functions of genes and gene products (proteins and noncoding RNAs). GO annotations cover genes from organisms across the tree of life as well as viruses, though most gene function knowledge currently derives from experiments carried out in a relatively small number of model organisms. Here, we provide an updated overview of the GO knowledgebase, as well as the efforts of the broad, international consortium of scientists that develops, maintains, and updates the GO knowledgebase. The GO knowledgebase consists of three components: (1) the GO-a computational knowledge structure describing the functional characteristics of genes; (2) GO annotations-evidence-supported statements asserting that a specific gene product has a particular functional characteristic; and (3) GO Causal Activity Models (GO-CAMs)-mechanistic models of molecular "pathways" (GO biological processes) created by linking multiple GO annotations using defined relations. Each of these components is continually expanded, revised, and updated in response to newly published discoveries and receives extensive QA checks, reviews, and user feedback. For each of these components, we provide a description of the current contents, recent developments to keep the knowledgebase up to date with new discoveries, and guidance on how users can best make use of the data that we provide. We conclude with future directions for the project.

A two year (2013 and 2014) field trial was conducted to study the residual effect of different fertility levels of rice mill ash (RMA) on maize-soybean intercrop. The experiment was arranged in a randomized complete block design (RCBD) comprising of nine (9) treatments and three (3) replications. The treatments where sole maize (SMO), sole soybean (SBO), maize/soybean intercrop without application of rice mill ash (IMBO), soybean + 10 t/ha rice mill ash (SB10), sole maize + 10 t/ha rice mill ash (SM10), maize - soybean intercrop + 10 t/ha rice mill ash (IMB10), sole maize + 20 t/ha rice mill ash (SM20); sole soybean + 20 t/ha rice mill ash (SB20) and maize/soybean intercrop + 20 t/ha rice mill ash (IMB20). Data generated was subjected to analysis of variance of which the result of the study showed that for 2 years under study, incorporated rice mill ash (RMA) and intercropping system significantly increased the soil productivity, yield and yield components of maize and soybean studied. The RMA at the rate of 20t/ha performed competitively better than the other treatments with strong residual impact on the parameters assessed. Findings from the study equally showed an intercrop advantage.

Food-borne disease outbreak have imposed substantial burden on health care systems and have markedly reduced the economic productivity of a country. Ready to eat food are well known source for bacteriological contamination with pathogen responsible for health hazard like food poisoning and diarrheal disease and they play significant role in transfer of antibiotic resistance. This study aims to evaluate bacteriological status of fried rice, jollof rice, turkey and chicken and the Antibiogram. A comparative study of the food samples was carried out using standard procedures for isolation and identification of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli as potential reservoir of human infection and transmitters of antimicrobial resistance. The prevalence of E. coli, K. pneumonia and P. aeruginosaand in food samples was found to be 68.45%, 20.24% and 11.31% respectively. E. coli showed good level of susceptibility to Tarivid 10mcg, Reflacine 10 mcg, Ciproflox 10 mcg and Streptomycin 30mcg. While K. pneumonia had fairly good susceptibility to Ciproflox 10 mcg, Streptomycin 30 mcg and Gentamycin 10mcg and P. aeruginosa was resistant to the antibiotics used. These data revealed also that the E. coli, K. pneumonia and P. aeruginosa isolates recovered from the food samples were resistant to multiple antimicrobials, which can be transmitted to humans through food products.

Hanjeli seeds are one of the typical Indonesian cereals that have great potential but their utilization is not optimal. In West Java, generally hanjeli seeds are only made into porridge and lunkhead. In this study, hanjeli seeds were processed into modified flour which was used to substitute wheat flour in the formulation of cupcake products. Modified hanjeli flour is produced from the following process, when raw hanjeli seeds are soaked in sodium metabisulfite (Na2S2O5) at concentrations of 50, 75 and 100 ppm for 36 hours, steamed, roasted, ground and sieved. The selected modified hanjeli flour was hanjeli flour with 75 ppm Na2S2O5 immersion which had a protein content of 13.35%. Furthermore, hanjeli flour is processed into cupcakes. The proportions of hanjeli flour substitution used in making cupcakes were 10, 20 and 30%. The cupcakes that have been produced are then tested hedonic (preferred). Based on these tests, it is known that the cupcake that has the highest score is the 10% modified hanjeli flour cupcake. Based on the results of the description test, it is known that the values ​​for the parameters of color brightness are 5.19 (slightly bright), sweetness level is 5.19 (slightly sweet), vanilla flavor sharpness is 5.42 (slightly sharp), vanilla aroma sharpness is 4.96 (ordinary) softness. the texture is 5.08 (slightly soft), the wetness of the crumb is 5.12 (slightly wet), and the elasticity of the texture is 5.00 (slightly chewy). ABSTRAKBiji Hanjeli merupakan salah satu serealia khas Indonesia yang sangat potensial tetapi pemanfaatannya belum optimal. Di Jawa Barat, umumnya biji hanjeli hanya dibuat bubur dan dodol. Dalam penelitian ini biji hanjeli diolah menjadi tepung modifikasi yang digunakan untuk mensubtitusi tepung terigu dalam formulasi produk cupcake. Tepung hanjeli modifikasi dihasilkan dari proses berikut biji hanjeli mentah direndam dengan Natrium metabisulfit (Na2S2O5) dengan konsentrasi 50, 75 dan 100 ppm selama 36 jam, dikukus, dioven, digiling dan diayak. Tepung hanjeli modifikasi yang terpilih adalah tepung hanjeli dengan perendaman 75 ppm Na2S2O5 yang memiliki kadar protein 13,35%. Selanjutnya tepung hanjeli diolah menjadi cupcake. Proporsi substitusi tepung hanjeli yang digunakan dalam pembuatan cupcake adalah 10, 20 dan 30%. Cupcake yang telah dihasilkan kemudian diuji hedonik (kesukaan). Berdasarkan uji tersebut diketahui bahwa cupcake yang memiliki skor tertinggi yaitu cupcake 10% tepung hanjeli modifikasi. Berdasarkan hasil uji deskripsi diketahui bahwa nilai untuk parameter kecerahan warna 5,19 (agak cerah), tingkat kemanisan 5,19 (agak manis), ketajaman rasa vanilla 5,42 (agak tajam), ketajaman aroma vanilla 4,96 (biasa) kelembutan tekstur 5,08 (agak lembut), kebasahan crumb 5,12 (agak basah), dan kekenyalan tekstur 5,00 (agak kenyal).

SUMMARY Objective This study aimed to evaluate the esthetic efficacy, cytotoxicity, and kinetics of decomposition of hydrogen peroxide (H2O2) present in a commercial bleaching gel with 35% H2O2 (BG35%) chemically activated with manganese oxide (MnO2). Methods and Materials After incorporating 2 mg/mL, 6 mg/mL, and 10 mg/mL of MnO2 into BG35%, the stability of pH and temperature of the products were analyzed. To assess the esthetic efficacy (ΔE and ΔWI), the BG35%s with MnO2 were applied for 45 minutes on enamel/dentin discs (DiE/D). BG35% or no treatment were used as positive (PC) and negative (NC) controls, respectively. To analyze the cell viability (CV) and oxidative stress (OXS), the same bleaching protocols were performed on DiE/D adapted to artificial pulp chambers. The extracts (culture medium + gel components that diffused through the discs) were applied to pulp cells and submitted to H2O2 quantification. BG35% with MnO2 that showed the best results was evaluated relative to kinetic decomposition of H2O2, with consequent generation of free radicals (FR) and hydroxyl radicals (OH•). The data were submitted to the one-way analysis of variance complemented by Tukey post-test (α=0.05). Data on kinetics of H2O2 decomposition were submitted to the Student’s-t test (α=0.05). Results All the BG35%s with MnO2 showed stability of pH and temperature, and the gel with 10 mg/mL of this activator had an esthetic efficacy 31% higher than that of the PC (p Conclusion Catalysis of BG35% with MnO2 minimized the trans-amelodentinal diffusion of H2O2 and toxicity of the product to pulp cells. BG35% containing 10 mg/mL of MnO2 potentiated the decomposition of H2O2, enhancing the generation of FR and OH•, as well as the efficacy of the in-office tooth therapy.

We analyzed sunspot tracers [sunspot number (SSN) and sunspot area (SSA)] and Coronal Mass Ejection (CME) observed parameters for cycle 23 and 24, comparing sunspot tracers time series with time series for CME parameters [Initial speed and Acceleration] for All and segregated CMEs for possible similarities in their variation pattern. A comparison of CME time series with solar activity (especially SSAT and SSN which seem to reflect the true general activity cycle) shows that fast CMEs follow the solar activity cycle but slow CMEs don’t. Also, CMEs with positive and negative acceleration follow the solar cycle but lags behind b 3monhs for cycle 24. However, the CME acceleration does not follow the solar cycle. CME distribution show that Slow CMEs increases in initial speed from one cycle to the other with a corresponding decrease in acceleration for CMEs with fast speeds. There is an almost insignificant increase in acceleration for CMEs with positive and negative acceleration. These charges are perhaps due to effect of solar wind.

ObjectiveTo investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases.DesignSystematic review incorporating meta-analysis.Data sourcesPubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus.Eligibility criteriaThe current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Trials analysing participants with chronic disease undergoing aerobic and/or resistance exercise training over videoconferencing, with exercise capacity and/or quality of life outcomes were included. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life. Risk of bias was analysed using the Downs and Black quality checklist and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).ResultsThirty-two trials were included in this review, of which 12 were comparator trials. Small–moderate between-group (videoconferencing vs comparator) effects favouring videoconferencing were seen for studies using a non-exercising comparator for exercise capacity (standardised mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=ConclusionIn patients with chronic disease, videoconferencing exercise interventions appear to be feasible and effective for improving exercise capacity and quality of life. More robust methodology is needed in future studies to improve the certainty of the evidence.PROSPERO registration numberCRD42020191243.

Background: Maternal anti-tetanus vaccination is required to prevent maternal and neonatal tetanus. In the absence of lifetime protective dosing, repeat vaccination in every new pregnancy is needed to achieve protection of the newborn against tetanus. Objectives: To determine maternal anti-tetanus vaccination schedule completion rates and the reasons for non-completion of the schedule. Methods: This cross-sectional survey was conducted among Nigerian antenatal clinic attendees using an interviewee-administered questionnaire. Results: Most (291/347; 83.9%) respondents had received a TT vaccine in the index pregnancy, and 280/347 (80.7%) received their first TT injection at the booking visit. In comparison, 202/238 (84.9%) of those eligible had received tetanus toxoid protective immunisation (TTPDI) in the index pregnancy. Although a majority (301/347; 86.7%) of the respondents had received at least a dose of TT in a previous pregnancy, only 23/246 (9.3%) eligible pregnant women had received complete vaccination (TT5) Parity (p

The risk of osteoporosis and fragility fracture is increased in patients with autoimmune rheumatic diseases. Although the use of glucocorticoids is the major contributing factor, inflammation mediated by cytokines and growth factors and other medications, including the biologic and targeted disease-modifying antirheumatic drugs, also play important roles in bone remodeling. Pro-inflammatory cytokines such as IL-1, IL-6, IL-17, and TNF[Formula: see text] increase RANK expression and promote osteoclast activity while inhibiting osteoblast-mediated bone formation through the Dickkopf-1 pathway. Certain autoantibodies stimulate differentiation of the osteoclasts, resulting in localized bone resorption. This article covers the prevalence and risk factors for osteoporosis in patients with common rheumatic diseases and the role of inflammatory cytokines and other clinical factors. Controlling disease-related inflammation and optimizing the diagnostic and therapeutic instrumentation is needed to reduce fragility fractures in patients with rheumatic diseases.

Previous research assumes that executive functions such as inhibition, shifting and updating explain individual differences in cognitive abilities. Of these three executive functions, updating was previously found to relate most strongly to fluid intelligence. However, this relationship could be a methodological artifact: Measures of inhibition and shifting usually isolate the contribution of this executive function to performance by contrasting conditions with high and low demands on these processes, whereas updating is measured by overall accuracy in working memory tasks involving updating. This updating measure conflates updating-specific individual differences (e.g., removal of outdated information) with variance in working memory maintenance. Re-analyzing data (N = 111) from von Bastian et al. (2016), we separated updating-specific variance from working memory maintenance variance. Updating contributed only 15% to individual differences in performance in the updating tasks, and it correlated neither with fluid intelligence nor with independent working memory measures reflecting storage and processing or relational integration. In contrast, the working memory maintenance component of the updating task correlated with both abilities. These findings challenge the view that updating contributes to variance in higher cognitive abilities.

Background Protecting a person’s right to privacy and confidentiality is important in healthcare services. As future health professionals, nursing students should bear the same responsibility as qualified health professionals in protecting patient privacy. Objectives To investigate nursing students’ practices of patient privacy protection and to identify factors associated with their practices. Research design A cross-sectional study design was adopted. A two-part survey was used to collect two types of data on nursing students: (1) personal characteristics, including demographics, clinical experience and use of information and communication technology and social media and (2) practice of patient privacy protection, collected using the Patient Privacy Scale. Participants and research context: A total of 319 nursing students aged 18 or above, studying pre-registration nursing programmes and who had attended at least one block of clinical placement, were recruited from a university in Hong Kong. Ethical considerations The study received ethical approval from the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong. The participants were informed of the study aim and written consent was obtained before completing the survey. Findings: The mean total score on the Patient Privacy Scale was 119.7 out of 135. Nursing students who were regular users of Instagram and those who had never taken photographs with patients and hence did not need to obtain patient consent were associated with better practices of patient privacy protection (higher total scores on the Patient Privacy Scale). Conclusions The findings improve our understanding of nursing students’ practice of patient privacy protection and the associated factors. This will inform the development and revision of current strategies to enhance nursing students’ practice of patient privacy protection, especially their use of social media.

C-type shocks are believed to be ubiquitous in turbulent molecular clouds thanks to ambipolar diffusion. We investigate whether the drag instability in 1D isothermal C-shocks, inferred from the local linear theory of Gu & Chen, can appear in nonideal magnetohydrodynamic simulations. Two C-shock models (with narrow and broad steady-state shock widths) are considered to represent the typical environment of star-forming clouds. The ionization-recombination equilibrium is adopted for the one-fluid approach. In the 1D simulation, the inflow gas is continuously perturbed by a sinusoidal density fluctuation with a constant frequency. The perturbations clearly grow after entering the C-shock region until they start being damped at the transition to the post-shock region. We show that the profiles of a predominant Fourier mode extracted locally from the simulated growing perturbation match those of the growing mode derived from the linear analysis. Moreover, the local growth rate and wave frequency derived from the predominant mode generally agree with those from the linear theory. Therefore, we confirm the presence of the drag instability in simulated 1D isothermal C-shocks. We also explore the nonlinear behavior of the instability by imposing larger-amplitude perturbations to the simulation. We find that the drag instability is subject to wave steepening, leading to saturated perturbation growth. Issues concerning local analysis, nonlinear effects, one-fluid approach, and astrophysical applications are discussed.

The study assessed the effects of demographic factors on population dynamics in Imo State, Nigeria. Multi-stage sampling technique was used select 60 respondents. Data collected were analyzed using descriptive statistics and the ordinary least square regression technique. Results showed that the area was dominated by female farmers 56.7%, and are married 66.7%. Most of the farming lands used was inherited, with more of hired laborers 76.7% used due to rural-urban drift. Results also showed that over 70% of the people migrated from rural to urban communities. Result further showed that age, gender, educational status, income level and poverty index were important and significant factors affecting population dynamics (expressed as index of rural–urban migration). The study recommended the crop farmers to join cooperative societies to raise funds to support large-scale production while the government is to provide basic rural infrastructures to checkmate rural-urban drift in the area.

Mossy cells (MCs) of the dentate gyrus (DG) are key components of an excitatory associative circuit established by reciprocal connections with dentate granule cells (GCs). MCs are implicated in place field encoding, pattern separation and novelty detection, as well as in brain disorders such as temporal lobe epilepsy and depression. Despite their functional relevance, little is known about the determinants that control MC activity. Here, we examined whether MCs express functional kainate receptors (KARs), a subtype of glutamate receptors involved in neuronal development, synaptic transmission and epilepsy. Using mouse hippocampal slices, we found that bath application of submicromolar and micromolar concentrations of the KAR agonist kainic acid induced inward currents and robust MC firing. These effects were abolished in GluK2 KO mice, indicating the presence of functional GluK2-containing KARs in MCs. In contrast to CA3 pyramidal cells, which are structurally and functionally similar to MCs, and express synaptic KARs at mossy fiber (MF) inputs (i.e., GC axons), we found no evidence for KAR-mediated transmission at MF-MC synapses, indicating that most KARs at MCs are extrasynaptic. Immunofluorescence and immunoelectron microscopy analyses confirmed the extrasynaptic localization of GluK2-containing KARs in MCs. Finally, blocking glutamate transporters, a manipulation that increases extracellular levels of endogenous glutamate, was sufficient to induce KAR-mediated inward currents in MCs, suggesting that MC-KARs can be activated by increases in ambient glutamate. Our findings provide the first direct evidence of functional extrasynaptic KARs at a critical excitatory neuron of the hippocampus.Significance StatementHilar mossy cells (MCs) are an understudied population of hippocampal neurons that form an excitatory loop with dentate granule cells. MCs have been implicated in pattern separation, spatial navigation, and epilepsy. Despite their importance in hippocampal function and disease, little is known about how MC activity is recruited. Here, we show for the first time that MCs express extrasynaptic kainate receptors (KARs), a subtype of glutamate receptors critically involved in neuronal function and epilepsy. While we found no evidence for synaptic KARs in MCs, KAR activation induced strong action potential firing of MCs, raising the possibility that extracellular KARs regulate MC excitability in vivo and may also promote dentate gyrus hyperexcitability and epileptogenesis.

Histopathological and immunohistochemical methods were used to diagnose round cell tumors in 2 subantarctic fur seals Arctocephalus tropicalis with marked anemia. Although wild-born, both individuals were placed under human care while juveniles in a Brazilian aquarium. Both pinnipeds were PCR tested for herpesvirus, and 1 was infected with otariid gammaherpesvirus 5 (OtHV-5), previously described in a subantarctic fur seal stranded in Brazil. Although some gammaherpesviruses can cause sarcomas and other neoplasms, it was not possible to definitively associate OtHV-5 with the neoplasm. To our knowledge, these are the first neoplasm records in subantarctic fur seals.

More than 98% of infant deaths occur in low- and middle-income countries (LMICs). Breastfeeding improves infant survival and protects against certain illnesses, such as diarrhea and pneumonia, which are leading causes of deaths in those5 years of age in LMICs. The World Health Organization (WHO) recommends early initiation of breastfeeding within 1 hour of birth, exclusive breastfeeding up to 6 months of age, and continued breastfeeding up to 2 years of age. However, fewer than half of infants in LMICs are breastfed optimally to these standards. The objectives of this article are to describe the global epidemiology and health benefits of breastfeeding with particular focus on LMICs.We searched PubMed to identify original research articles on breastfeeding in LMICs and reviews related to the benefits of breastfeeding, with particular focus on articles published in the past 5 years. We used reports and data published by the WHO and the United Nations Children's Fund (UNICEF) related to global breastfeeding rates, targets, and programmatic initiatives. We used the Lives Saved Tool to estimate mortality related to breastfeeding practices.Less than half of infants globally receive early, exclusive, or continued breastfeeding. Certain high-risk groups, such as premature or HIV-exposed infants, face particular challenges and benefits related to breastfeeding. The WHO, UNICEF, and other global partners have developed a multipronged strategy to promote global breastfeeding, ranging from government-level advocacy to grassroots community support groups. Using the Lives Saved Tool, we estimate that nearly 200,000 lives of those5 years of age could be saved in LMICs from 2020 to 2030 if early, exclusive, and continued breastfeeding rates were linearly increased from current rates to meet the WHO 2030 goals of 60% to 80% coverage. If this goal were exceeded and near-universal coverage were achieved, the number of lives would increase even further such that820,000 lives per year could potentially be saved by universal breastfeeding. In this review, we delineate the health and economic benefit of breastfeeding in LMICs, discuss breastfeeding epidemiology in the global context, and describe targeted strategies to improve breastfeeding uptake.